AmbuFlex

Use of Patient Reported Outcome (PRO) in the clinic
Traditionally, control of outpatients is part of the standardised treatment. However, often the consultation proves unnecessary if, in advance, the health professionals have had access to few essential data on the state of the patient. Conversely, a clinically insignificant impairment can occur between scheduled consultations. If knowledge of the state of the patient can be provided without causing extra time consumption for the health professionals involved, resources can be transferred to patients with greater needs.

What is AmbuFlex?
AmbuFlex is a generic web-based system which supports flexible outpatient treatment by means of PRO for clinical decision support. The patients answer clinically relevant questionnaires regarding e.g. symptoms, well-being and functional capacity.
A graphical overview of the treatment, on the basis of the answers of the patients, is available for the outpatient staff via the Electronic Health Record system (Columna). This ensures quick access and overview of the treatment, and moreover, it constitutes the basis of effective decision support. In the long term, the patient will be able to access his or her answers via The Danish e-Health Portal (sundhed.dk).
High response rates are required in order to use PRO in the clinic. To ensure this a mixed-mode system is used. The mixed-mode system means that the patient can choose the questionnaire to be answered on paper by mail or as an electronic questionnaire on the Internet. This results in response rates between 80 and 95% depending on the population.

Purpose

Improve the quality of treatment
• Provide an overview of the treatment
• Increase documentation
• Object-oriented consultations
Further patient involvement
• Focus on the patient as an active co-player
• Outpatient treatment based on patient needs
• Learning potential
Better use of resources
• Optimisation of consultations
• Reduce unnecessary consultations
Collect data for research and quality development

Initiation of a new AmbuFlex project?

AmbuFlex is developed primarily for use in group of patients with chronic diseases with many visits in outpatient clinics and where PRO is a central source of information to evaluate the patient’s present state.

It will therefore be relevant to consider the following aspects, before initiating a new AmbuFlex-project:

1. What would we like to know about our patients – and how should the information be applied in the clinic?
2. Is AmbuFlex suitable for the patient group in question?
3. Who will be in charge of the implementation?

Regarding 1. Questionnaire and design of AmbuFlex
The questionnaire is essential in AmbuFlex. The clinicians are experts within their field, and consequently, they know which questions and answers are relevant to assess the state of the patient. The questionnaire is developed in close cooperation between clinicians, patients and AmbuFlex staff.
PRO data can be applied in the clinic in different ways. Should the patients answer the questionnaire at home so it can be used to assess their needs of a physical consultation and in this way function as clinical decision support in terms of allocating which patients should be seen in the outpatient clinic – or alternatively, should PRO data be used to optimise the consultation before which the patient could answer the questionnaire in the waiting room?

Regarding 2. Patient groups suited for AmbuFlex
The patient groups suited for AmbuFlex are characterised by:
• Comprehensive outpatient treatment with many contacts
• The questionnaire answers provided by the patient should be essential for the clinical assessment of the state of the patient
• A clinical examination must not be necessary to assess the state of the patient whereas laboratory data such as blood sample results can be applied by means of look-ups in electronic patient or health records e.g. Midt-EPJ.

Regarding 3. What does the implementation of AmbuFlex require from the department?
If a questionnaire has not already been developed and tested by the patient group, a successful implementation and use of AmbuFlex require that some of the potential users will participate in the development of the questionnaire and in the trial period during which the systems should be adjusted to the individual department and its reorganisation. As with many other projects, the implementation of AmbuFlex requires support from the management.

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